Provider Demographics
NPI:1003526039
Name:REDDIX, NIEONTRA NICOLLE
Entity Type:Individual
Prefix:
First Name:NIEONTRA
Middle Name:NICOLLE
Last Name:REDDIX
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 2ND ST UNIT 1964
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458-3206
Mailing Address - Country:US
Mailing Address - Phone:985-710-5303
Mailing Address - Fax:
Practice Address - Street 1:1950 2ND ST UNIT 1964
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-3206
Practice Address - Country:US
Practice Address - Phone:985-710-5303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-30
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA008108474343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)